The purpose of this proposal is to support protected time for Dr. Sharon Moe to continue her own clinical research and to mentor new investigators in the musculoskeletal diseases observed in dialysis patients. Dr. Moe has a proven track record in patient oriented research, strong mentoring history, and continuous extramural funding for translational and patient oriented research projects. Her long term research goals are to understand and treat the interrelated disorders of altered mineral metabolism, abnormal bone turnover, and increased vascular calcification in patients with chronic kidney disease (CKD), all associated with increased morbidity and mortality. During the 5 years of her previous K24, Dr. Moe has or is mentoring 13 individuals, 4 faculty (one with a K01, one with a pending K23, and one with an ADA career development award), 1 internal medicine housestaff (now a Nephrologist), and 8 Nephrology trainees (3/6 have completed their training and remain in academics). During the present K24 award, Dr. Moe has 29 peer-reviewed manuscripts, 20 of which include mentees as authors, in topics of vascular calcification and renal osteodystrophy. Dr. Moe's mentoring plan includes 1) regular meetings with mentees to discuss their research project and career development, 2) design and work on an investigator initiated project, 3) experience writing grants, abstracts, and manuscripts, 4) experience with presentation of results at national meetings, and 5) exposure to inter-disciplinary collaborative research. The research planned for the K24 renewal include projects to evaluate the role of mechanisms of vascular calcification and the role of alternative forms of dialysis, inflammation, and fetuin-A in calcification. Other studies will compare the use of inactive versus active vitamin D to treat secondary hyperparathyroidism in CKD, the role of bisphosphonates in the treatment of vascular calcification and osteoporosis in dialysis patients, and the relationship of hepatitis C and CKD. These studies, Dr. Moe, and the strong clinical research support at Indiana Unviersity provide an excellent training environment for the development of future investigators in patient oriented research.